cut-practice-Letter to CJ, HC mumbai

From,


Dr Vani Kulhalli

Vile Parle East

Mumbai-57



To,

Honorable Chief Justice

High Court of Mumbai

Mumbai.



Date- 9-7-2013



Subject- Petition to intervene in the matter of Dr Bawaskar vs P M Medical Centre, Pune currently being handled by the Maharashtra Medical Council (MMC)



Respected Sir,



I am a Psychiatrist practicing in Mumbai for the last 10 years. I have seen the harm done to the community by ‘cut-practice’ and believe that it is a horrible form of corruption that should be immediately stopped. In this regard, I had filed RTI applications to the Medical Council of India and Maharashtra Medical Council in 2012 (enclosure). Although the Indian Medical Council Regulations of 2002 mentions cut-practice as illegal, there is no mention of the procedures to establish the misconduct or the quantum and nature of punishment. I was also surprised that the Councils had not even thought of setting up a group/ committee to deliberate in this matter in the several decades of their existence!



All members of the current MMC are doctors or beaurocrats. They are not well versed in judging misdemeanors of this (financial and ethical) nature. Their role in this case will be limited to merely hear the case and settle it. Secondly, they are mostly busy doctors doing the council work in honorary capacity and cannot spare the time or energy required. Thirdly, being doctors it will not be easy for them to be objective in the respect of a practice that has spread its tentacles over most of the medical community. Sometimes fraternal ties make it difficult to give out proper decisions. Therefore, I have serious doubts about the competence and credibility of MMC to handle this case.



The procedure used for settling this case will only involve hearing both parties. No investigation will be done to establish the facts of the case. For example, simply checking other cases handled by the diagnostic centre will be able to tell us whether it routinely reimbursed ‘professional charges’ to doctors for the favour of referring patients (in other words, did cut practice). So the question of a misunderstanding arising in this particular case only, will not arise. I fear that this type of investigative approach will not be taken for the reasons stated above. The whole purpose of the complaint and the intention of the complainant to cleanse medical practice will be lost.



A patient goes to his doctor in pain and desperation, with a hope not only of treatment but also of empathic guidance and support. If the doctor is motivated by empathy and informed by scientific facts, this patient can get what he needs. This is a basic human right. There is no law that forbids the doctor from framing and then claiming his/ her fees for this service. That amount may be high or low, as per the doctor’s judgement. Inspite of this, it is my personal experience that all patients pay the fees asked of them. Then what is the need to fool the patient into paying through cut-practice network?



Thus cut-practice is not motivated by lack of income alone. It is the work of a perverse mind motivated by a criminal intent. This is perpetrated by group of individuals who seek to defraud the patient and are unconcerned with the risk that the patient is exposed to, in undergoing unnecessary tests and surgeries. Therefore, it should be classified as a premeditated criminal activity done with the astute planning of an intelligent but sick mind. All sections of society and every profession have such members. In the medical community, they are represented by professionals who believe cut-practice is their entitlement. This makes it necessary to punish the holders of such malafide intent to protect humanity.



Further, it gives unfair advantage those doctors who are corrupt and can be justly termed as an ‘illegal trade practice’. A group of such doctors form a cartel and edge out other doctors. The doctor or hospital who bribes corners a large clientele and this affects the morale of non- corrupt doctors. It is now known that such persons are able to get income tax benefits as paying ‘referral charges’ has been ruled as a legitimate business expense. The doctor who refers the patients need not use his/ her skills as a doctor as the income from kickbacks frequently exceeds income from hard work and is home-delivered by a ‘P R O’. (Public Relations Officer)



A person who pays a bribe to get some work done does it for himself, is aware that he is paying, is aware why he paying it, is aware to whom he is paying and at least some of the times, has the choice not to pay. The hapless patient has no idea that he/ she has been taken for a ride by the doctors with whom he/ she trusted his life. The very nature of cut-practice makes it impossible for the victim to take precautions. The victim will never be able to get redress even if he becomes aware; a strong sense of fraternity will prevent any doctor from being a witness and there are no other witnesses in this crime. Therefore cut practice is the worst form of corruption and it denies the patient his basic human rights. And that is why Dr Bawaskar’s case is of extreme importance. For the first time, we have a doctor willing to go on record and remedy the practice and he has followed the proper procedure.



According to me cut-practice is a crime against humanity. It is so well organized; I wish the doctors should be booked under MCOCA or some such similar law. I feel it is an economic offence against the state, where the recipients of kickbacks are not paying the proper taxes due to invisible transactions whereas the kickback generators are evading tax in the name of business expense. There is artificial inflation of medical costs as the kickbacks amount to anything between 40-60% of medical expenses. It is destroying the moral fabric of medical community by making the wrong people rich and successful. Cut practice is an insidious and horrible practice that hits out at the very base of humanity. I have now seen the worrying trend of specialist doctors doing general practice only for the sake of cashing in on this cut-practice trend.



I plead to your Kind Lordship to take cognizance of the extreme importance of this case. A rare case such as Dr Bawaskar’s, is a once in the life time opportunity to give out a strong message of zero tolerance to cut-practice. Cut- practice is a serious crime. I and others like me, think that it is a matter in the public interest and Maharashtra Medical Council does not have sufficient stature or competence to deliberate on a matter of such national and human importance. It is our humble plea that the case should be handled by an August and eminently competent body such as the Honorable High Court itself. The case should be investigated by a proper agency such as Police or Economic Offences Wing and case pleaded by proper lawyers. The Honorable Court may deem fit to suo moto issue relevant guidelines or at least appoint a observer of proven integrity to monitor and report to the Honorable High Court and His Kind Lordship about the proceedings in this case.



Enclosures

Contents of application to Medical Council

of India and Maharashtra Medical Council

under RTI Act 2005

With Highest Hope from You, Sir

Sincerely,

Dr Vani B Kulhalli



_______________________________________________________________________________

RTI Apploication to MCI in Feb 2012

In the last ten years, that is during the period from January 2002 to December 2011, regarding ‘cut-practice’ by which I mean the system of a doctor giving commission to another doctor for the ‘service’ of referring patients:



1. Against how many doctors has the Medical Council of India (MCI) received complaints for doing cut-practice? I want to know the total numbers including those giving as well as those receiving cuts.



2. How many doctors suspected of doing cut-practice were investigated by MCI?



3. In case the allegation of cut-practice against any doctor was proved to be true, what was the punishment/ penalty imposed on such a doctor?



4. Did the MCI receive any complaints that a hospital/ nursing home/ diagnostic centre or such other commercial establishment rendering medical services, was involved in cut-practice? If yes, how many complaints were received?



5. How many complaints of cut-practice against commercial medical establishments were investigated by the MCI?



6. In case any commercial medical establishment was found to be engaging in cut-practice, what was the punishment/ penalty imposed?



7. Has there been any request to Medical council of India to designate cut-practice as an illegal activity tantamount to corruption?



8. Has there been any plan/ proposal of the MCI to declare cut-practice as a form of corruption?



REPLY Dated-28-3-2012

Total number of complaints, that is, 588 against doctors working in private practice/ nursing homes/ private hospital/ Govt. hospital during January 2011 to March 2012 has been received by council. It is further to state that no complaint has been received for doing cut-practice.

MCI has prescribed the Indian Medical Council (Professional Conduct, etiquette and Ethics ) Regulations, 2002 which is available on website www.mciindia.org. The Council does not maintain the data in the manner in which it is sought for.

It is further stated that the queries are in the nature of eliciting opinion and therefore, it does not constitute information as defined under u/s(f) of the RTI Act 2005.

Signed

Dr Davinder Kumar

Joint Secretary and PIO




--------------------------------------------------------------------------------------------------------

rti application to MMC


Nature of Information required



In the last ten years, that is during the period from January 2002 to December 2011, regarding ‘cut-practice’ by which I mean the system of a doctor giving commission to another doctor for the ‘service’ of referring patients:



1. Against how many doctors has the MMC received complaints for doing cut-practice? I want to know the total numbers including those giving as well as those receiving cuts.



2. How many doctors suspected of doing cut-practice were investigated by MMC?



3. In case the allegation of cut-practice against any doctor was proved to be true, what was the punishment/ penalty imposed on such a doctor?



4. Did the MMC receive any complaints that a hospital/ nursing home/ diagnostic centre or such other commercial establishment rendering medical services, was involved in cut-practice? If yes, how many complaints were received?



5. How many complaints of cut-practice against commercial medical establishments were investigated by the MMC?



6. In case any commercial medical establishment was found to be engaging in cut-practice, what was the punishment/ penalty imposed?



7. Has there been any request to MMC to designate cut-practice as an illegal activity tantamount to corruption?



8. Has there been any plan/ proposal of the MMC to declare cut-practice as a form of corruption?



RTI Query filed in February 2012, answer received in same month

Ref no-MMC/ RTI/ 04450/ 2012/ 2543

Answers received were

1. As of date MMC has not received any complaint for doing cut-practice, against any individual doctors

2. & 3. Not applicable

4. As of date MMC has not received any complaint against any hospital/ nursing home/ diagnostic centre

5,6,7. Not applicable

8. No proposal pertaining to cut-practice is tabled in MMC.



Signed-Dr Ramesh Dahigaonkar, Information Officer/ Registrar, MMC